Macular Degeneration: Schein OD

West ES, Schein OD. · Johns Hopkins University School of Medicine, 116 Wilmer Building, 600 N. Wolfe Street, Baltimore, MD 21287-0919, USA. · Int Ophthalmol Clin. · Pubmed #15632526 No free full text.

This publication has no abstract.

Muñoz B, West SK, Rubin GS, Schein OD, Quigley HA, Bressler SB, Bandeen-Roche K. · Wilmer Eye Institute, The Johns Hopkins University, 600 N Wolfe St, Room 116, Baltimore, MD 21287, USA. · Arch Ophthalmol. · Pubmed #10865321 No free full text.

Abstract: OBJECTIVE: To determine the causes of blindness and visual impairment in a population-based sample of older Americans. METHODS: A random sample of 3821 residents of Salisbury, Md, between the ages of 65 and 84 years was identified from Medicare records. Sixty-six percent (2520 persons) agreed to undergo an eye examination; 26% of the participants were African American. The clinical examination included acuity testing with an Early Treatment Diabetic Retinopathy Study chart and standardized refraction testing for those with a visual acuity worse than 20/30, slitlamp and dilated retinal examination by an ophthalmologist, tonometry, lens and fundus photography, and a suprathreshold visual field test. Visual impairment was defined as a best-corrected acuity in the better-seeing eye worse than 20/40 and better than 20/200, while blindness was acuity in the better-seeing eye of 20/200 or worse. For those with a visual acuity worse than 20/40 in either eye, one or more causes were assigned by an ophthalmologist and a final cause for each eye was confirmed by a panel of 3 subspecialty ophthalmologists (O.D.S., H.A.Q., and S.B.B.) based on all available evidence. RESULTS: Bilateral presenting acuity worse than 20/40 increased from 4% in the 65- to 74-year age group to 16% in the 80- to 84-year age group. One third of those with presenting acuity worse than 20/40 improved to 20/40 or better with refraction. Overall, 4.5% had a best-corrected acuity worse than 20/40. African Americans were more likely to remain visually impaired than were whites despite refraction (odds ratio [95% confidence interval], 1.7 [1.1-2.6]). Whites were most often impaired or blind from age-related macular degeneration (1.2% vs 0.5%; P=.09). African Americans had higher rates of impairment and blindness from cataract or posterior capsular opacification (2.7% vs 1.1%; P=.006), glaucoma (0.9% vs 0.1%; P=.006), and diabetic retinopathy (1.2% vs 0.2%; P=. 004). CONCLUSIONS: More than half of those with visual impairment or blindness had conditions that were either surgically treatable or potentially preventable. African Americans had a disproportionate number of blinding diseases, particularly those amenable to eye care intervention. Targeted interventions for specific populations to increase appropriate eye care use would greatly improve vision and function in older Americans. Arch Ophthalmol. 2000;118:819-825

Schein OD, Bressler NM, Price P. · Department of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-9019, USA. · Arch Ophthalmol. · Pubmed #15642813 No free full text.

Abstract: OBJECTIVE: To assess adherence to Food and Drug Administration-approved indications and Centers for Medicare & Medicaid Services policy through June 2001 regarding the use of photodynamic therapy in Medicare beneficiaries. DESIGN: Systematic review of pretreatment fluorescein angiograms of 1245 consecutive Medicare patients who received photodynamic therapy from physicians in 3 contiguous Medicare coverage areas (fee-for-service arrangement) and in 136 consecutive patients in a Medicare health maintenance organization. RESULTS: In the 3 Medicare fee-for-service regions, payment denial due to nonconforming fluorescein angiograms ranged from 17% to 29% by region in 1245 beneficiaries. In the health maintenance organization setting, 60 (44%) of 136 submitted angiograms were nonconforming, including 8 in which the photographic quality was too poor to grade the lesion size, composition, or both. CONCLUSIONS: A substantial proportion of the actual or intended clinical application of photodynamic therapy with verteporfin was directed to patients who did not meet concurrent published clinical criteria associated with treatment benefit or national coverage policy. Although this policy has evolved, it still depends on fluorescein angiographic interpretation, suggesting that there is an opportunity to improve the cost-effectiveness of delivery of photodynamic therapy with verteporfin to Medicare beneficiaries.

Freeman EE, Munoz B, West SK, Tielsch JM, Schein OD. · Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-9019, USA. · Am J Ophthalmol. · Pubmed #12788126 No free full text.

Abstract: PURPOSE: To determine whether cataract surgery is associated with an increased prevalence of age-related macular degeneration (AMD) in three independent population-based data sets. DESIGN: Cross-sectional study. METHOD: Data were used from the Salisbury Eye Evaluation (2,520 subjects from Salisbury, Maryland, aged 65 to 84 years), the Proyecto VER (4,774 Hispanic subjects from Arizona aged 40 years and older), and the Baltimore Eye Survey (4,396 subjects from Baltimore, Maryland, aged 40 and older). The main outcome measure was AMD as determined by retinal photographs or clinical examination. RESULTS: A history of cataract surgery was associated with an increased prevalence of late AMD in all three data sets after adjusting for age, race, sex, and smoking, but odds ratios (OR) were not individually statistically significant. The OR for the combined analysis was 1.7 (95% confidence interval: 1.1-2.6). Having a severe cataract in the eye was also associated with a slightly higher prevalence of late AMD, although the combined OR was not statistically significant (OR = 1.4; 95% confidence interval, 0.8%-2.4). Overall, increasing time since cataract surgery was not associated with late AMD. CONCLUSIONS: A history of cataract surgery may be associated with an increased prevalence of late AMD. However, having a severe cataract in the eye may also be associated with a higher prevalence of late AMD. Additional research is needed to investigate whether a causal relationship exists between cataract surgery and AMD or whether this relationship is due to residual confounding or bias.